Preventive Medicine

The article “Federal Guidelines Help M.D.s Avoid Billing Errors” in the November 17, 2000, issue mentioned the “feeding frenzy for consultants” that these guidelines have created. This is true for one reason and one reason only: Physicians do not know how to code accurately. As a certified professional coder, I review physicians’ records from both extremes of the spectrum.

The majority of physicians are performing the work and just do not document well or do not know how to code accurately for maximum reimbursement. The solution to their problem is a little education, practice, and confidence. There is a small minority of physicians, however, who are truly trying to cheat the system, and it is because of these physicians that the Office of the Inspector General (OIG) and other government offices have come down so hard on coding and billing.

The following two excerpts come directly from the OIG guidelines and follow the course the OIG will take to ensure compliance.

“It is advisable that bills and medical records be reviewed for compliance with applicable coding, billing, and documentation requirements. . . . [T]hese self-audits would ideally include the person in charge of billing and a medically trained person, preferably a physician. . . .

“Coding and billing training on the federal health care program requirements may be necessary for certain members of the physician practice staff. The OIG understands that most physician practices do not employ a professional coder and that the physician is often primarily responsible for all coding and billing. However, it is in the practice’s best interest to ensure that individuals who are directly involved with billing, coding, or other aspects of the federal health care programs receive extensive education specific to that individual’s responsibilities. Training may be conducted either in-house or by an outside source. Training at outside seminars, instead of internal programs and in-service sessions, may be an effective way to achieve the practice’s training goals. The OIG recommends that there be at least an annual training program for all individuals involved in the coding and billing aspects of the practice. Ideally, new billing and coding employees will be trained as soon as possible.”

A little prevention and education up front can go a long way for most physicians. Ignoring these guidelines will not make them go away. We have two choices—either become active in the process to change it for the better and learn the rules of the game, or get out of the game.